Benzoquinone derivative e3330 in combination with chemotherapeutic agents for the treatment of cancer and angiogenesis

ABSTRACT

Disclosed are novel methods for the therapeutic treatment of cancer and angiogenesis. The enzyme Ape1/Ref-1, via its redox function, enhances the DNA binding activity of transcription factors that are associated with the progression of cancer. The present invention describes the use of agents to selectively inhibit the redox function of Ape1/Ref-1 and thereby reduce tumor cell growth, survival, migration and metastasis. In addition, Ape1/Ref-1 inhibitory activity is shown to augment the therapeutic effects of other therapeutics and protect normal cells against toxicity. Further, Ape1/Ref-1 inhibition is shown to decrease angiogenesis, for use in the treatment of cancer as well other pathologic conditions of which altered angiogenesis is a component.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a Continuation application of U.S. patent application Ser. No.16/377,442 (published as U.S. Publication No. 2019/0231728) filed onApr. 8, 2019, which is a Continuation application of U.S. patentapplication Ser. No. 16/044,981 filed on Jul. 25, 2018, which is aContinuation application of U.S. patent application Ser. No. 14/690,973(now U.S. Pat. No. 10,058,523) filed on Apr. 20, 2015, which is aContinuation application of U.S. patent application Ser. No. 12/679,824(now U.S. Pat. No. 9,040,505) filed on Jul. 6, 2010, which is a U.S.national counterpart application of international application serial No.PCT/US2008/077210 filed on Sep. 22, 2008, which claims priority to U.S.Provisional Patent Application No. 60/975,396 filed on Sep. 26, 2007 andto U.S. Provisional Patent Application No. 60/989,566 filed on Nov. 21,2007, each of which is incorporated by reference herein in its entirety.

FIELD OF THE INVENTION

The present invention relates generally to the fields of molecularbiology, biochemistry, and pathology. More specifically, in certainaspects, the invention relates to the use of Ape1/Ref-1 redox inhibitorsin the treatment of cancer and for inhibition of angiogenesis.

BACKGROUND OF THE INVENTION

Apurinic/apyrimidinic endonuclease (Ape 1), also known as redox effectorfactor (Ref-1) (hereinafter Ape1/Ref-1) is an enzyme with a dual role.In addition to its DNA base excision repair (BER) activity, Ape1/Ref-1also functions as a redox effector maintaining transcription factors inan active reduced state (see FIG. 1).

Ape1/Ref-1 has been shown to stimulate the DNA binding activity ofseveral transcription factors such as HIF-1α, NFκβ, AP-1 and p53, andothers known and unknown, which are related to tumor survival andprogression (Evans et al., Mutat Res 2000, 461, 83). Ape1/ref-1expression has been shown to be altered in a variety of cancersincluding breast, cervical, germ cell tumors, adult and pediatricglio-mas, osteosarcomas, rhabdomyosarcomas, non-small cell lung cancer,and multiple myeloma (Puglisi et al., Oncol Rep 2002, 9, 11; Thomson etal., Am J Pediatr Hematol Oncol 2001, 23, 234; Roberston et al., CancerRes 2001, 61, 2220; Puglisi et al., Anticancer Res 2001, 21, 4041;Koukourakis et al., Int J Radiat Oncol Biol Phys 2001, 50, 27; Kakolyriset al., Br J Cancer 1998, 77, 1169; Bobola et al., Clin Cancer Res 2001,7, 3510). High Ape1/Ref-1 expression has also been associated with apoor outcome for chemoradiotherapy, poor complete response rate, shorterlocal relapse-free interval, poorer survival, and high angiogenesis(Koukourakis et al., Int J Radiat Oncol Biol Phys 2001, 50, 27;Kakolyris et al., Br J Cancer 1998, 77, 1169; Bobola et al., Clin CancerRes 2001, 7, 3510).

Angiogenesis is an important component of cancer growth, survival,migration, and metastasis. The formation of new blood vessels at thesite of a cancerous tumor provides a source of nutrients for acceleratedtumor growth and expansion as well as a path for tumor cells to enterthe bloodstream and spread to other parts of the body. Thus, effectiveinhibition of angiogenesis is a useful mechanism to slow or prevent thegrowth and spread of cancer. An increase in Ape1/Ref-1 activity has beenassociated with angiogenesis. Vascular endothelial growth factor (VEGF)is an important signaling protein involved in both vasculogenesis andangiogenesis. Ape1/Ref-1 is a component of the hypoxia-inducibletranscriptional complex formed on the vascular endothelial growth factor(VEGF) gene's hypoxic response element (Ziel et al., Faseb J2004, 18,986).

In addition to cancer, altered angiogenesis contributes to pathologicalconditions related to, among others, cardiovascular disease, chronicinflammatory disease, rheumatoid arthritis, diabetic retinopathy,degenerative maculopathy, retrolental fibroplasias, idiopathic pulmonaryfibrosis, acute adult respiratory distress syndrome, asthma,endometriosis, psoriasis, keloids, and systemic sclerosis. Inhibition ofangiogenesis is a desirable clinical outcome for the amelioration orprevention of diseases involving excessive angiogenesis.

SUMMARY OF THE INVENTION

Targeted inhibition of the redox function of Ape1/Ref-1 is a novelapproach to the treatment of cancer and angiogenesis. In one embodiment,the present invention is directed to the use of anticancer therapeuticagents that inhibit the redox function of Ape1/Ref-1. In anotherembodiment, the present invention is directed to anti-angiogenic agentsthat inhibit the redox function of Ape1/Ref-1.

In one embodiment, the present disclosure is directed to a method ofreducing angiogenesis in a subject in need thereof, the methodcomprising: administering to the subject in need thereof an effectiveamount of 3-[(5-(2,3-dimethoxy-6-methyl1,4-benzoquinoyl)]-2-nonyl-2-propenoic acid; a pharmaceuticallyacceptable salt or a pharmaceutically acceptable solvate thereof.

In another embodiment, the present disclosure is directed a method ofinhibiting Vascular Endothelial Growth Factor (VEGF) release in asubject in need thereof, the method comprising: administering to thesubject in need thereof an effective amount of3-[(5-(2,3-dimethoxy-6-methyl 1,4-benzoquinoyl)]-2-nonyl-2-propenoicacid; a pharmaceutically acceptable salt or a pharmaceuticallyacceptable solvate thereof.

In yet another embodiment, the present disclosure is directed to amethod of reducing tubulogenesis in a subject in need thereof, themethod comprising: administering to the subject in need thereof aneffective amount of 3-[(5-(2,3-dimethoxy-6-methyl1,4-benzoquinoyl)]-2-nonyl-2-propenoic acid; a pharmaceuticallyacceptable salt or a pharmaceutically acceptable solvate thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. Redox role of Ape1/Ref-1 in the regulation of transcriptionfactors important in tumor survival.

FIG. 2. VEGF enzyme-linked immunosorbent assay (ELISA).

FIGS. 3A & 3B. VEGF ELISA Assay.

FIGS. 4A & 4B. VEGF ELISA Assay.

FIG. 5. VEGF ELISA Assay.

FIG. 6. VEGF ELISA Assay.

FIG. 7. VEGF ELISA Assay.

FIG. 8. Capillary tube formation assay using CB-ECFC cells plated onMATRIGEL®.

FIG. 9. Limiting dilution assay (LDA).

FIG. 10. MTS Proliferation Assay with retinal endothelial cellproliferation in cells treated with or without basic fibroblast growthfactor (bFGF).

FIG. 11. Effect of E3330 (RN3-3) on the proliferation of retinalvascular endothelial cells (RVEC)-wild/sv40 cells.

FIG. 12. MTS assay using MCF-7 tumor cells derived from human breastadenocarcinoma.3-(4-5-Dimeth-ylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophe-nyl)-2H-tetrazoliumsalt (MTS) assay used for cell survival/growth analysis.

FIG. 13. MTS assay using OVCAR-3 tumor cells derived from human ovarianadenocarcinoma.

FIGS. 14A-14D. Effect of E3330 (RN3-3) in combination with thechemotherapeutic drug melphalan on multiple myeloma cells.

FIG. 15. Effect of E3330 (RN3-3) in combination with chemotherapeuticdrug melphalan on multiple myeloma cells in the MTS assay after 72hours.

FIG. 16. Effect of E3330 (RN3-3) and gemcitabine (0.25 μM) on pancreatictumor cells at 24 and 48 hours.

FIG. 17. MTS cell viability assay.

FIG. 18. MTS cell viability assay.

FIG. 19. Body weight in male mice administered E3330 (RN3-3) (0-50mg/kg).

FIG. 20. Survival data of mice treated with RN3-3 (E3330) at variousamounts and observed on days 2, 3, 4 or 5 after treatment.

FIGS. 21A & 21B. Pharmacokinetic data of E3330 (RN3-3) over a 24 hr timecourse experiment.

FIG. 22. Pharmacokinetic data for E3330 (RN3-3).

FIG. 23. Effect of E3330 (RN3-3) and retinoic acid on promoting celldifferentiation.

FIG. 24. Apoptosis analysis of HL-60 cells treated as described in FIG.23 using annexin/PI assay.

FIG. 25. Effect of RN3-3 (E3330) and various doses of RA.

FIG. 26. Effect of E3330 (RN3-3) and RA on HL-60 cells undergoingapoptosis (annexin/PI assay).

FIGS. 27A-27D. Effect of E3330 (RN3-3) in combination with the smallmolecule methoxyamine on multiple myeloma cells.

DETAILED DESCRIPTION

The present invention is directed to the use of anti-cancer andanti-angiogenic agents that selectively inhibit the redox function ofApe1/Ref-1. Such selective inhibition includes specific inhibition, or,in other words, where there is no or no appreciable effect on the BERfunction of APE1/Ref-1, as well as where the predominant effect is onthe redox function, vis-a-vis the BER function. Also encompassed by theinvention is the use of such agents in combination with additionalchemotherapeutic/therapeutic agents. It is desired that the other agentswork on a subject in a different way to that of the agents whichselectively inhibit the redox function of Ape1/Ref1.

Physiological disorders associated with altered angiogenesis encompassthose disorders associated with inappropriate angiogenesis, which aredirectly or indirectly deleterious to the subject. Altered angiogenesiscontributes to pathological conditions related to, among others, cancer(including growth, survival, migration, microenvironment, andmetastasis), and cardiovascular disease, chronic inflammatory disease,rheumatoid arthritis, diabetic retinopathy, degenerative maculopathy,retrolental fibroplasias, idiopathic pulmonary fibrosis, acute adultrespiratory distress syndrome, asthma, endometriosis, psoriasis,keloids, and systemic sclerosis.

The term subject includes vertebrate animals, and preferably is a humansubject. The term inhibit, and derivatives thereof, includes itsgenerally accepted meaning, which includes prohibiting, preventing,restraining, and slowing, stopping, or reversing progression orseverity. Thus, the present methods include both medical therapeutic andpro-phylactic administration, as appropriate. As such, a subject in needthereof, as it relates to the therapeutic uses herein, is one identifiedto require or desire medical intervention. An effective amount is thatamount of an agent necessary to inhibit the pathological diseases anddisorders herein described. When at least one additional therapeuticagent is administered to a subject, such agents may be administeredsequentially, con-currently, or simultaneously, in order to obtain thebenefits of the agents.

The redox function of Ape1/Ref-1 was found to be selectively inhibitedby 3-[(5-(2,3-dimethoxy-6-methyl1,4-benzoquinoyl)]-2-nonyl-2-proprionicacid, below (hereinafter “E3330”, also referred to as “RN3-3” in thisapplication). Further information on E3330 may be found in Abe et al.,U.S. Pat. No. 5,210,239, fully incorporated herein by reference.Particularly, processes for preparing, formulations, andpharmaceutically acceptable salts are described.

Interestingly, our research indicates that selective blocking of theredox function of Ape1/Ref-1 does not cause any or any appreciableapoptosis in normal cells. One very well might expect that the selectiveblocking resulting in increased apoptosis in cancerous cells would alsoimpair normal cells. However, we have not found this to be the case.

Where subject applications are contemplated, particularly in humans, itwill be necessary to prepare pharmaceutical compositions in a formappropriate for the intended application. Generally, this will entailpreparing compositions that are essentially free of impurities thatcould be harmful to a subject.

The agents can be administered orally, intravenously, intramuscularly,intrapleurally or intraperitoneally at doses based on the body weightand degree of disease progression of the subject, and may be given inone, two or even four daily administrations.

One will generally desire to employ appropriate salts and buffers torender agents stable and allow for uptake by target cells. Aqueouscompositions of the present invention comprise an effective amount ofthe agent, dissolved or dispersed in a pharmaceutically acceptablecarrier or aqueous medium. Such compositions also are referred to asinnocuously. The phrase pharmaceutically or pharmacologically acceptablerefers to molecular entities and compositions that do not produceadverse, allergic, or other untoward reactions when administered to asubject. As used herein, pharmaceutically acceptable carrier includesany and all solvents, dispersion media, coatings, antibacterial andantifungal agents, isotonic and absorption delaying agents and the like.The use of such media and agents for pharmaceutically active sub-stancesis well known in the art. Supplementary active ingredients also can beincorporated into the compositions.

Compositions for use in the present invention may include classicpharmaceutical preparations. Administration of these compositionsaccording to the present invention will be via any common route so longas the target tissue is available via that route. This includes oral,nasal, buccal, rectal, vaginal or topical. Alternatively, administrationmay be by orthotopic, intradermal, subcutaneous, intramuscular,intraperitoneal or intravenous injection. Such compositions wouldnormally be administered as pharmaceutically accept-able compositions,described supra.

For example, the compounds can be formulated with common excipients,diluents, or carriers, and formed into tablets, capsules, suspensions,powders, and the like. Examples of excipients, diluents, and carriersthat are suitable for such formulations include the following: fillersand extenders such as starch, sugars, mannitol, and silicic derivatives;binding agents such as carboxymethyl cellulose and other cellulosederivatives, alginates, gelatin, and polyvinyl pyrrolidone; moisturizingagents such as glycerol; disintegrating agents such as calcium carbonateand sodium bicarbonate; agents for retarding dissolution such asparaffin; resorption accelerators such as quaternary ammoniumcom-pounds; surface active agents such as cetyl alcohol, glycerolmonostearate; adsorptive carriers such as kaolin and bentonite; andlubricants such as talc, calcium and magnesium stearate, and solidpolyethyl glycols.

The active compounds may also be administered parenterally orintraperitoneally. Solutions of the active com-pounds as free base orpharmacologically acceptable salts can be prepared in water suitablymixed with a surfactant, such as hydroxypropylcellulose. Dispersions canalso be prepared in glycerol, liquid polyethylene glycols, and mixturesthereof and in oils. Under ordinary conditions of storage and use, thesepreparations contain a preservative to prevent the growth ofmicroorganisms.

The pharmaceutical forms suitable for injectable use include sterileaqueous solutions or dispersions and sterile powders for theextemporaneous preparation of sterile injectable solutions ordispersions. In all cases the form must be sterile and must be fluid tothe extent that easy syringability exists. It must be stable under theconditions of manufacture and storage and must be preserved against thecontaminating action of microorganisms, such as bacteria and fungi. Thecarrier can be a solvent or dispersion medium containing, for example,water, ethanol, polyol (for example, glycerol, propylene glycol, andliquid polyethylene glycol, and the like), suitable mixtures thereof,and vegetable oils. The proper fluidity can be maintained, for example,by the use of a coating, such as lecithin, by the maintenance of therequired particle size in the case of dispersion and by the use ofsurfactants. The prevention of the action of microorganisms can bebrought about by various antibacterial and antifungal agents, forexample, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, andthe like. In many cases, it will be preferable to include isotonicagents, for example, sugars or sodium chloride. Prolonged absorption ofthe injectable compositions can be brought about by the use in thecompositions of agents delaying absorption, for example, aluminummonostearate and gelatin.

Sterile injectable solutions are prepared by incorporating the activecompounds in the required amount in the appropriate solvent with variousof the other ingredients enumerated above, as required, followed byfiltered sterilization. Generally, dispersions are prepared byincorporating the various sterilized active ingredients into a sterilevehicle which contains the basic dispersion medium and the requiredother ingredients from those enumerated above. In the case of sterilepowders for the preparation of sterile injectable solutions, thepreferred methods of preparation are vacuum-drying and freeze-dryingtechniques which yield a powder of the active ingredient plus anyadditional desired ingredient from a previously sterile-filteredsolution thereof.

For oral administration agents of the present invention may beincorporated with excipients and used in the form of non-ingestiblemouthwashes and dentifrices. A mouthwash may be prepared incorporatingthe active ingredient in the required amount in an appropriate solvent,such as a sodium borate solution (Dobell's Solution). Alternatively, theactive ingredient may be incorporated into an antiseptic wash containingsodium borate, glycerin and potassium bicarbonate. The active ingredientmay also be dispersed in dentifrices, including gels, pastes, powdersand slurries. The active ingredient may be added in a therapeuticallyeffective amount to a paste dentifrice that may include water, binders,abrasives, flavoring agents, foaming agents, and humectants.

The compositions for use in the present invention may be formulated in aneutral or salt form. Pharmaceutically-acceptable salts include the acidaddition salts (formed with the free amino groups of the protein) andwhich are formed with inorganic acids such as, for example, hydrochloricor phosphoric acids, or such organic acids as acetic, oxalic, tartaric,mandelic, and the like. Salts formed with the free carboxyl groups canalso be derived from inorganic bases such as, for example, sodium,potassium, ammonium, calcium, or ferric hydroxides, and such organicbases as isopropylamine, trimethylamine, histidine, procaine and thelike.

Upon formulation, solutions will be administered in a manner compatiblewith the dosage formulation and in such amount as is therapeuticallyeffective. The formulations are easily administered in a variety ofdosage forms such as injectable solutions, drug release capsules and thelike. For parenteral administration in an aqueous solution, for example,the solution should be suitably buffered if necessary and the liquiddiluent first rendered isotonic with sufficient saline or glucose. Theseparticular aqueous solutions are especially suitable for intravenous,intramuscular, subcutaneous and intraperitoneal administration. In thisconnection, sterile aqueous media which can be employed will be known tothose of skill in the art in light of the present disclosure. Forexample, one dosage could be dissolved in 1 ml of isotonic NaCl solutionand either added to 1000 ml of hypodermoclysis fluid or injected at theproposed site of infusion, (see for example, “Remington's PharmaceuticalSciences” 15th Edition, pages 1035-1038 and 1570-1580). Some variationin dosage will necessarily occur depending on the condition of thesubject being treated. The person responsible for administration will,in any event, determine the appropriate dose for the individual subject.Moreover, for human administration, preparations should meet sterility,general safety and purity standards as required by FDA and foreigncounterpart agencies.

Inhibition of the redox function of Ape1/Ref-1 was shown to decreaseVEGF release, impair capillary tube formation, and inhibit the growth oflarge cell number colonies, indicating anti-angiogenic activity. Thefollowing examples are for illustrative purposes only and are notintended to limit the scope of the present invention.

Inhibition of VEGF release. VEGF enzyme-linked immunosorbent assay(ELISA). Various cancer cell lines were plated in a 24-well plate andtreated in duplicates with for about 24 hrs in normoxic (about 21%oxygen) or hypoxic (about 2% oxygen) condition. The supernatants ofcells were collected and subjected to an ELISA assay with a kit specificfor human VEGF according to the manufacturer (R&D Systems, Minneapolis,Minn.). VEGF ELISA assay results were read in a 96-well format platereader by measuring absorbance at 450 nm with correction at 540 nm.Hypoxia induced an increase in VEGF release (FIG. 2). (For FIGS. 2-7,black bars=normoxia; gray bars=hypoxia.)

VEGF ELISA Assays. Hey-C2 (ovarian cancer), SKOV-3X (ovarian cancer),Panc1 (pancreatic cancer), PaCa-2 (pancreatic cancer), and Igrov(ovarian cancer) cells were plated in a 24-well plate and treated induplicates with E3330 (RN3-3 e) at different concentrations for about 24hrs in normoxic (about 21% oxygen) or hypoxic (about 2% oxygen)condition. The supernatants of cells were collected and subjected to anELISA assay with a kit specific for human VEGF according to themanufacturer (R&D Systems, Minneapolis, Minn.). VEGF ELISA assay resultswere read in a 96-well format plate reader by measuring absorbance at450 nm with correction at 540 nm. E3330 (RN3-3e) reduced the amount ofVEGF release from the cells under both normoxia and hypoxia conditionsthrough inhibition of Ape 1/Ref-1 redox function (FIGS. 2-7).

Inhibition of capillary tube formation. The capillary tube formationassay was performed using CB-ECFC cells plated on MATRIGEL® and treatedwith E3330 or control media. ECFCs were cultured as previously described(Blood, 1 Nov. 2004, Vol. 104, No. 9, pp. 2752-2760). ECFC coloniesappeared between 5 and 22 days of culture. Colonies were counted byvisual inspection using an inverted microscope (Olympus, Lake Success,N.Y.) under ×40 magnification. Cells were passaged as previouslydescribed. Blood, 1 Nov. 2004, Vol. 104, No. 9, pp. 2752-2760.)

The tube formation assay was performed as described previously (J. Biol.Chem. 274 (1999), pp. 35562-35570). Various concentrations of E3330 weregiven to CB-ECFCs for about 30 min at room temperature before seedingand plated onto the layer of MATRIGEL® at a density of about 1×10⁴cells/well. After about eight hours, the enclosed networks of completetubes from randomly chosen fields were counted and photographed under amicroscope. E3330 and its analogues inhibit tube formation, an indicatorof anti-angiogenesis and growth inhibition (FIG. 8).

Limiting dilution assay. E3330 inhibit growth of large cell numbercolonies in the limiting dilution assay (LDA) which is also an indicatorof anti-angiogenesis (FIG. 9). ECFCs were cultured as previouslydescribed (Blood, 1 Nov. 2004, Vol. 104, No. 9, pp. 2752-2760). ECFCcolonies appeared between 5 and 22 days of culture. Colonies and thenumber of cells per colony were counted by visual inspection using aninverted microscope. E3330 inhibit growth of large cell number coloniesin the limiting dilution assay (LDA) which is also an indicator ofanti-angiogenesis. Increasing amounts of E3330 (RN3-3) leads to adecrease in the number of colonies with large numbers of cells and anincrease in colonies with only small cell numbers indicative ofinhibition of cell growth. (FIG. 9). (In FIG. 9, the bars are, left toright, EtOH, and E330 dosed at 25 μM, 37.5 μM, and 50 μM.)

Inhibition of endothelial cell proliferation. E3330 at about 10-100 μMdecreased retinal endothelial cell proliferation in cells treated withor without basic fibroblast growth factor (bFGF). Young adult mouseretinal tissues were dissected out and digested. Cells were plated in 24well plates and grown to confluence, then seeded to 96 well plates forassay. Three days after seeding, the total number of cells was assayedby MTS measurement (Promega). The proliferation rate was calculatedaccording to manufacturer's instructions. Proliferations of RECs fromdifferent groups were compared for statistical significance. E3330(RN3-3) blocked REC proliferation indicative of anti-blood vesselformation effects. (FIG. 10)

E3330 10-100 μM decreased cell proliferation of retinal vascularendothelial cells (RVEC) (FIG. 11). In basal media, E3330 inhibited REVCcell proliferation at all 4 concentrations tested, 10 μM-57%, 25 μM-93%(p<0.01). REC proliferation was significantly boosted when bFGF wasadded in the media. A similar inhibitory effect was also seen in bFGFmedia at 10 μM, 25 μM, and higher concentration of E3330.

In vitro tube formation assay. Additionally, it was observed that in anassay observing in vitro tube formation, E3330, like AVASTINO, preventedformation of blood-vessel-like tubules in endothelial cells, in a dosedependent manner. In that assay it was also observed that a combinationuse of AVASTIN® and E3330 was synergistically more effective than eitheralone.

SNV in vldlr−/− knockout mice assay. It has been observed E3330intravitreal treatment significantly reduces the number of subretinalneovascularization (SNV) in vldlr−/− retina. Experiments were carriedout in very-low-density lipoprotein receptor (vldr) knockout mice todetermine the effect of E3330 on inhibition of SNV development in thevldlr−/− mutant. Each animal received a single intravitreal injection of1 μl volume of BSS as a vehicle control and the fellow eye received 1 μlof 200 nm E3330. The final concentration of E3330 was equivalent toapproximately 20 μM in the retina. Quantitative measurement of SNV wascarried out one week after the treatment in the whole mount retina afterlectin-FITC staning. The results showed that 17/20 individuals hadreduced number of SNV in the eyes treated with E3330 with −30%reduction. In contrast, neither AVASTINO (VEGF antibody) nor bFGFantibody treatment showed any sign of inhibition to the number of SNV.The apparent increase of SNV after antibody injection could be due toforeign protein triggered immune response which has been reported before(Tator et al., 2008). E3330 reduced the number of SNV at a statisticallysignificant level (p<0.01 in paired t-test). These data are veryencouraging as this model of retinal angiomatous proliferation (RAP),similar to human, is difficult to treat and does not respond well tocurrent avail-able treatments including anti-VEGF and anti-bFGF agents.The Ape1/Ref-1 inhibitor offers a new approach to control angiogenesisfor advanced macular degeneration (AMD) treatment.

The present invention also encompasses the use of agents that inhibitthe redox function of Ape1/Ref-1 as anti-cancer therapeutics. Suchcancers include breast, prostate, pancreatic, colon, cervical, germ celltumors, adult and pediatric gliomas, osteosarcomas, rhabdomyosarcomas,non-small cell lung cancer, leukemias, and multiple myeloma. Ape1/Ref-1has been shown to stimulate the DNA binding activity of severaltranscription factors such as HIF-1α, NFκβ, AP-1 and p53, which arerelated to tumor survival and progression. Selective inhibition of theredox function of Ape1/Ref-1 by E3330 decreases the binding oftranscription factors to DNA and impairs the ability of cancer cells tothrive. The following examples are for illustrative purposes only andare not intended to limit the scope of the present invention.

Decreased cancer cell survival. MCF-7 or OVCAR-3 cells (about 2-4,000)were aliquoted into each well of a 96-well plate in triplicate andallowed to adhere overnight. E3330 (RN3-3) was added to the cultures.After about or 72 h, about 0.05 mg/mL3-(4-5-Dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazoliumsalt (MTS) reagent was added to each well and incubated at about 37° C.for about 4 h followed by absorbance measurement at 490 nm. The valueswere standardized to wells containing media alone. Independently, E3330dose dependently killed MCF-7 tumor cells derived from human breastadenocarcinoma (FIG. 12) and OVCAR-3 tumor cells derived from humanovarian adenocarcinoma (FIG. 13). Similar effects can be seen inmultiple myeloma, prostate, non-small cell lung carcinoma, colon, andglioma derived cells. In contrast, significant growth inhibition in ourstudies with normal cells such as hematopoietic embryonic cells or inhuman CD34+ progenitor cells was not observed. These data are novel inthat they implicate the redox role of Ape1/REF-1 in cancer, but not“normal” cell survival.

Glioma Cell Migration Assay. E3330 was tested to determine if it wouldinhibit the migration ability of SF767 glioma cells. In order to dothis, we plated 1.5×10⁶ SF767 cells in a 60 mm tissue culture dish andallowed them to attach overnight and form a confluent monolayer. Ascratch or wound was made across the plate using a 200 μL pipette tip asdescribed previously (Liang 2007). The cells were then rinsed to removefloating cells and media contain 25, 50, 75 or 100 μM E3330 or theappropriate vehicle control, DMSO. The drug-containing media was removedafter 24 h and fresh media was added. Images were taken at three markedplaces along the scratch at 0, 24, 36 and 48 h after the drug was added.Migration was quantified in ten uniform places for each image takenusing Spot Software (Diagnostic Instruments, Sterling Heights, Mich.) tomeasure the distance in microns between the leading edges of thescratch. Each set of data, a total of thirty for each data point, wasnormalized to the migration of the vehicle control at 0 h and used todetermine standard deviation. The results indicate the E3330 inhibitedthe ability of the SF767 cells to migrate, and exhibited as much as4.0-fold inhibition with 100 μM E3330-treated cells as compared to thevehicle control at 48 h.

Our results support an effect on the microenvironment, or stroma. Themicroenvironment, which is distinct from the cancer cells per se, playsa part in a tumor's progression, including metastasis. It can limit theaccess of therapeutics to the tumor, alter drug metabolism, andcontribute to drug resistance. Clearly, being able to affect themicroenvironment can assist in the ultimate therapeutic results achievedin regard to tumors.

In another embodiment, the present invention is directed to the use ofagents that inhibit the redox function of Ape1/Ref-1 in combination withother therapeutics. Such therapeutics include, but are not limited to,melphalan, gemcitabine, cisplatin, methoxyamine, thalidomide and itsderivatives, and retinoic acid (RA). Selective Ape1/Ref-1 inhibition canact synergistically with other therapeutics to increase anticancerefficacy. Thus, lower doses of therapeutics, which cause sickness andare toxic to normal cells at higher doses, can be administered without adecrease in anti-cancer efficacy. Use of agents that selectively inhibitthe redox function of Ape1/Ref-1 can provide protection for normal cellsagainst the effects of cisplatin and other chemotoxic compounds. Thefollowing examples are for illustrative purposes only and are notintended to limit the scope of the present invention.

E3330 in combination with chemotherapeutic Melphalan. E3330 incombination with the chemotherapeutic drug melphalan synergisticallyenhanced killing of multiple myeloma cells (FIGS. 14A-14D). Synergisticplots made using CalcuSyn software. E3330 was either given alone or incombination with melphalan. As an indicator of DNA double strandedbreaks (DSBs), the phosphorylation of histone H2AX at Ser¹³⁹ wasmeasured with a phosphorylation-specific H2AX antibody from Upstate CellSignaling Solutions (Waltham, Md.). Cells were treated with melphalanalone or melphalan plus E3330. After drug treatment, exponentiallygrowing cells were harvested, washed in cold PBS, and lysed in about 100μL RIPA assay buffer as described above. Protein was quantified andelectrophoresed in SDS gel-loading buffer on a 12% SDS-polyacrylamidegel. Mouse monoclonal anti-phosphohistone H2AX (about 1:1000) oranti-actin antibody (about 1:1000; as a loading control, LabVisionCorp., NeoMarkers, Fremont, Calif.) was used to probe for protein levelsas described previously. Bands were detected using a chemiluminescencekit from Roche Applied Biosciences (Indianapolis, Ind.). The bands werevisualized using Bio-Rad Chemidoc XRS (Hercules, Calif.) and quantitatedusing Chemidoc software, Quantity One 4.6.1. There is an increase inDSBs in the melphalan plus E3330 (RN3-3) compared to melphalan alone.

E3330 (RN3-3) was applied in combination with the chemotherapeutic drugmelphalan and was found to synergistically enhance the killing ofmultiple myeloma cells in the MTS assay after 72 hours (FIG. 15). E3330(RN3-3) was either given alone or in combination with melphalan and theED50 plotted against the percent control as per the CalcuSyn softwarewhich is based on the Chou-Talalay algorithm (Chou-Talalay; Advances inEnzyme Regulation 22, 27-55). Melphalan plus E3330 (RN3-3) is moreeffective than either agent alone.

E3330 in combination with chemotherapeutic Gemcitabine. E3330 enhancedthe apoptosis inducing effects of gemcitabine (about 0.25 μM) inpancreatic tumor cells (FIG. 16). To analyze the cells for apoptosis,cells were plated and allowed to attach overnight. Cells were treatedwith E3330 alone or with gemcitabine. Apoptosis was assayed about 24 and48 hr following treatment. Cells were trypsinized, pelleted, washed inice-cold PBS, and resuspended in 1× binding buffer [about 10 mmol/LHEPES/NaOH (pH 7.4), 140 mmol/L NaCl, 2.5 mmol/L CaCl₂]. Apoptosis wasanalyzed using the Alexa Fluor 488 AnnexinV from Vybrant Apoptosis Assaykit in combination with propidium iodide (Molecular Probes, Eugene,Oreg.) as described previously Clinical Cancer Research 13, 260-267,Jan. 1, 2007. Cells that were strongly Annexin positive were consideredpositive for apoptosis. The samples were analyzed by flow cytometry inthe Indiana University Cancer Center flow cytometry facility.

E3330 in combination with chemotherapeutic Cisplatin. Concentrations ofE3330 as high as about 120 μM did not impair the survival of rat dorsalroot ganglion cells growing in culture for up to about 72 hours, asmeasured by the MTS cell viability assay (FIG. 17). There was no effectof E3330 (RN3-3) on the post-mitotic DRG cells, indicative of anon-toxic effect of E3330 (RN3-3) on non-dividing cells.

DRG cell cultures and treatments were performed similar to previouslypublished procedures using just E3330 alone (DNA Repair Volume 4, Issue3, 2 Mar. 2005, pp 367-379). Further, E3330 provided protection againstthe neuro-toxic effects of the chemotherapeutic cisplatin whenadministered to rat dorsal root ganglion cells (FIG. 18). Thisdemonstrates that while E3330 (RN3-3) enhances some chemotherapeuticagents, it has a protective effect on non-dividing, post-mitotic cells(e.g. DRG cells) even in the presence of a chemotherapeutic agent.

E3330 in combination with Retinoic Acid. E3330 enhanced the effects ofretinoic acid on promoting cell differentiation (FIG. 23). HL-60 cellswere treated with either vehicle (EtOH; control), E3330, retinoic acid(RA) or E3330 and RA at the concentrations indicated and morphologydetermined on day six. Morphological analysis indicated an increase inthe differentiation of the HL-60 cells treated with E3330 (RN3-3).Apoptosis analysis of HL-60 cells at day 6 revealed that the combinationof E3330 and RA showed an increase in the number of cells undergoingapoptosis com-pared to the cells treated with E3330 alone, and about a1.5 increase compared with RA alone at the 25 μM dose E3330 (FIG. 24).

E3330 enhanced the effect of RA at the 1000 fold lower dose of RA, butresulted in similar levels of differentiation as with the higher dosesof RA. CD11, which is a marker for HL-60 differentiation, demonstratedthat the addition of E3330 to RA allows for about 1000 fold (3 orders ofmagnitude) less RA being required to have the same level ofdifferentiation as at higher doses of RA (FIG. 25).

E3330 did not significantly enhance the level of HL-60 cells undergoingapoptosis (annexin/PI assay) at lower doses of RA even though the levelof differentiation was greatly enhanced by about 1000 fold (FIG. 26).

These results indicate that E3330 plus RA leads to cell differentiationbut not increased apoptosis in these cells and model system at thereduced doses of RA.

E3330 in combination with Methoxyamine-multiple myeloma cells. E3330 incombination with the small molecule methoxyamine enhanced killing ofmultiple myeloma cells as assayed by MTS (FIGS. 27A-27D). Data wascalculated using the CalcuSyn software which is based on theChou-Talalay algorithm (Chou-Talalay; Advances in Enzyme Regulation 22,27-55). E3330 was either given alone or in combination withmethoxyamine.

As an indicator of DNA double stranded breaks (DSBs), thephosphorylation of histone H2AX at Seri 39 was measured with aphosphorylation-specific H2AX antibody from Upstate Cell SignalingSolutions (Waltham, Md.). Cells were treated with E3330 alone or E3330plus methoxyamine. After drug treatment, exponentially growing cellswere harvested, washed in cold PBS, and lysed in about 100 [IL RIM assaybuffer as described above. Protein was quantified and electrophoresed inSDS gel-loading buffer on a 12% SDS-polyacrylamide gel. Mouse monoclonalanti-phosphohistone H2AX (about 1:1000) or anti-actin antibody (about1:1000; as a loading control, LabVision Corp., NeoMarkers, Fremont,Calif.) was used to probe for protein levels as described previously.Bands were detected using a chemiluminescence kit from Roche AppliedBiosciences (Indianapolis, Ind.). The bands were visualized usingBio-Rad Chemidoc XRS (Hercules, Calif.) and quantitated using Chemidocsoftware, Quantity One 4.6.1.

E3330 in combination with Methoxyamine-pancreatic cells. E3330 enhancedthe apoptosis inducing effects of methoxyamine in pancreatic tumor. Toanalyze the cells for apoptosis, cells were plated and allowed to attachovernight. Cells were treated with E3330 alone or with methoxyamine.Apoptosis was assayed about 24 and 96 hr following treatment. Cells weretrypsinized, pelleted, washed in ice-cold PBS, and resuspended in 1×binding buffer [about 10 mmol/L HEPES/NaOH (pH 7.4), 140 mmol/L NaCl,2.5 mmol/L CaCl₂]. Apoptosis was analyzed using the Alexa Fluor 488Annexin V from Vybrant Apoptosis Assay kit in combination with propidiumiodide (Molecular Probes, Eugene, Oreg.) as described previouslyClinical Cancer Research 13, 260-267, Jan. 1, 2007. Cells that werestrongly Annexin positive were considered positive for apoptosis. Thesamples were analyzed by flow cytometry in the Indiana University CancerCenter flow cytometry facility.

Preliminary in vivo experiments. Preliminary in vivo experiments in micewere performed to explore the safety profile and determine thepharmacokinetic properties of E3330 (FIGS. 19-22).

FIG. 19. Body weight in male mice administered E3330 (RN3-3) (0-50mg/kg). No mouse toxicity was observed with E3330 (RN3-3) under 50mg/kg. Mice were treated with RN3-3 (E3330) and weighed either two daysbefore treatment or following treatment with the three doses ofcompound.

FIG. 20. Survival data of mice treated with RN3-3 (E3330) at variousamounts and observed on days 2, 3, 4 or 5 after treatment. The number ofsurviving mice over the total number are presented as surviving/total.

FIGS. 21A & 21B. Pharmacokinetic data of E3330 (RN3-3) over a 24 hr timecourse experiment. Mice were treated with E3330 (RN3-3) and then theblood concentration detected in the Clinical Pharmacology and AnalyticalCore (CPAC). The time vs. concentration of E3330 (RN3-3) is plotted(FIG. 21B) and the estimated concentration is shown in the table (FIG.21A). Three mice were used at each time point and the data representsthe mean with SD (not shown) plotted for each time.

FIG. 22. Pharmacokinetic data for E3330 (RN3-3). Data from the survival,weight and PK studies were collected and are shown in this table. Thehalf-life of RN3-3 (E3330) was determined for male, female and combinedmice as well as their weight and concentrations.

What is claimed is:
 1. A method of treating psoriasis in a subject inneed thereof, the method comprising: administering to the subject inneed thereof an effective amount of 3-[(5-(2,3-dimethoxy-6-methyl1,4-benzoquinoyl)]-2-nonyl-2-propenoic acid; a pharmaceuticallyacceptable salt or a pharmaceutically acceptable solvate thereof.
 2. Themethod of claim 1, wherein at least one additional therapeutic agent isadministered to the subject.
 3. The method of claim 2, wherein theadditional therapeutic agent is an inhibitor of at least one of NuclearFactor kappa-light-chain-enhancer of activated B (NFκB) pathway, Signaltransducer and activator of transcription 3 (STAT3) pathway, andHypoxia-inducible factor 1 (HIF-1) pathway.
 4. The method of claim 1,wherein the effective amount ranges from about 10 μM to about 100 μM. 5.A method of treating rheumatoid arthritis in a subject in need thereof,the method comprising: administering to the subject in need thereof aneffective amount of 3-[(5-(2,3-dimethoxy-6-methyl1,4-benzoquinoyl)]-2-nonyl-2-propenoic acid; a pharmaceuticallyacceptable salt or a pharmaceutically acceptable solvate thereof.
 6. Themethod of claim 5, wherein at least one additional therapeutic agent isadministered to the subject.
 7. The method of claim 6, wherein theadditional therapeutic agent is an inhibitor of at least one of NuclearFactor kappa-light-chain-enhancer of activated B (NFκB) pathway, Signaltransducer and activator of transcription 3 (STAT3) pathway, andHypoxia-inducible factor 1 (HIF-1) pathway.
 8. The method of claim 5,wherein the effective amount ranges from about 10 μM to about 100 μM. 9.A method of treating acute adult respiratory distress syndrome in asubject in need thereof, the method comprising: administering to thesubject in need thereof an effective amount of3-[(5-(2,3-dimethoxy-6-methyl1,4-benzoquinoyl)]-2-nonyl-2-propenoicacid; a pharmaceutically acceptable salt or a pharmaceuticallyacceptable solvate thereof.
 10. The method of claim 9, wherein at leastone additional therapeutic agent is administered to the subject.
 11. Themethod of claim 10, wherein the additional therapeutic agent is aninhibitor of at least one of Nuclear Factor kappa-light-chain-enhancerof activated B (NFκB) pathway, Signal transducer and activator oftranscription 3 (STAT3) pathway, and Hypoxia-inducible factor 1 (HIF-1)pathway.
 12. The method of claim 9, wherein the effective amount rangesfrom about 10 μM to about 100 μM.